'Designing Better Health Care in the South': A Case Study of Unsuccessful Transformational Change in Public Sector Health Service Reform

This article presents a case study of a project known as 'Designing Better Health Care in the South' that attempted to transform four separately incorporated health services in southern Adelaide into a single regional health service. The project's efforts are examined using Kotter's (1996) model of the preconditions for transformational change in organisations and the areas in which it met or failed to meet these preconditions are analysed, using results from an evaluation that was commenced during the course of the attempted reform. The article provides valuable insights into an attempted major change by four public sector health organisations and the facilitators and barriers to such change. It also examines the way in which forces beyond the control of individual public sector agencies can significantly impact on attempts to implement organisational change in response to an identified need. This case study offers a rare glimpse into the micro detail of health care reform processes that are so widespread in contemporary health services but which are rarely systematically evaluated.     

Information and party voting in “semipartisan” judicial elections

Research on the relationship between the quantity of information that voters possess and their party voting behavior in partisan elections has produced mixed and confusing empirical results. In an effort to provide a broader perspective, this paper explores that relationship in nonpartisan elections contested by candidates of opposing parties. The paper analyzes survey data on two 1984 contests for seats on the Ohio Supreme Court, using the presidential race for comparison. Despite a highly partisan campaign, party defections by voters were far more common in the supreme court races than in the presidential race, reflecting the importance of party designations on the ballot as a source of information on candidates' party affiliations. At the individual level, levels of information had differing effects in the two supreme court races and for Democratic and Republican voters; this finding suggests that the impact of imformation levels on voters' choices is conditioned by the content of information in particular campaigns.     

Looking Ahead: Addressing Ethical Challenges in Public Health Practice

Ethical challenges in public health can have a significant impact on the health of communities if they impede efficiencies and best practices. Competing needs for resources and a plurality of values can challenge public health policymakers and practitioners to make fair and effective decisions for their communities. In this paper, the authors offer an analytic framework designed to assist policymakers and practitioners in managing the ethical tensions they face in daily practice. Their framework is built upon the following set of six considerations: determining population-level utility of the proposed action; demonstrating evidence of need and effectiveness of actions; establishing fairness of goals and proposed implementation strategies; ensuring accountability; and, assessing expected efficiencies and costs associated with the proposed action. Together, these considerations create a structured guide to assist decision-makers in identifying potential ethical challenges and in assessing the moral considerations that underlie public health practice - and possibly even, if the conditions are met, reduce the creation of ethical tension. Although the authors'empirical experiences provide the basis for the framework advanced here, their approach remains to be tested and evaluated by public health practitioners.     

Britain's ‘betrayal’ of Hong Kong: A second look

Claims of British bungling and betrayal were repeatedly raised during the prolonged run‐up to the 1997 Hong Kong handover. This paper seeks to evaluate such claims. It examines five controversial episodes of reputed British mishandling of the Hong Kong transition: (1) Governor Murray MacLehose's reputed double faux pas of March 1979, when the governor first putatively erred by prematurely (and unnecessarily) raising the ‘1997 question’ in a routine meeting with Deng Xiaoping and then compounded his error by misrepresenting Deng's less‐than‐reassuring response; (2) Prime Minister Margaret Thatcher's 1982 miscalculation in requesting a 50‐year extension of the New Territories lease when it was already abundantly clear that Chinese leaders regarded the original lease as ‘unequal'—and therefore non‐binding; (3) Britain's 1987 decision to unilaterally postpone Hong Kong's first direct legislative elections, a decision defended on the disingenuous grounds that government surveys had revealed a majority of the Hong Kong public to be opposed to rapid democratization; (4) Britain's ostensible failure, in the aftermath of the 1989 Tiananmen debacle, to secure the inclusion of adequate democratic safeguards in the final draft of the Hong Kong Basic Law, completed early in 1990; and (5) Governor Chris Patten's ill‐starred democratic reform initiatives of 1992–95, which sharply reversed Britain's previous ‘convergence’ policy and ultimately led to the derailing of Hong Kong's vaunted ‘through train’. Examining available evidence on these five episodes (and one or two other, related cases), this paper argues that despite occasional, palpable policy miscalculations and a notable lack of official candor, Britain did not do serious harm to the vital interests of Hong Kong. On the contrary, the paper argues, given the substantial advantage in resources and leverage enjoyed by the Chinese side throughout the transition period, a more favorable outcome could hardly have been achieved. The one residual allegation of British betrayal that cannot readily be countered, however, is the charge that racism within Britain's ruling Conservative Party—manifested in Parliamentary legislation severely restricting the flow of immigrants from British colonial territories—played a significant role in the British Government's choice of tactics in dealing with the ‘1997 question’.     

On universal relevance in legal reasoning

The purpose of this essay is to defend a claim that a certain consideration, which I call unworkability, is universally and necessarily relevant to legal reasoning. By that I mean that it is a consideration that must carry legal weight in the justification of some judicial decisions in every legal system in which (1) all disputed matters of law can be adjudicated, and (2) all judicial decisions are to be legally justified. Unworkability's necessary relevance has important implications for a theory of relevance presented by Rolf Sartorius. On this theory, nearly all considerations that are relevant to a judicial decision are supplied by legal principles embedded in the legal rules and decisions, or by extralegal principles dependent, in some way, on the legal principles. (The exceptions to the embedding thesis that Sartorius would, no doubt, recognize are elaborated in the text but can be set aside here.) But there are possible legal systems which do not contain an embedded legal principle concerning unworkability; and nonetheless, unworkability is relevant to judicial reasoning in those systems. Hence, a theory of relevance that relies on principles embedded in the content of rules is too simplistic. Some substantive considerations are relevant for other reasons.     

Most in Need But Least Served: Legal and Practical Barriers to Special Immigrant Juvenile Status for Federally Detained Minors

Abused, neglected, and abandoned immigrant youth face numerous obstacles to physical safety, including potential repatriation (deportation) to abusive caretakers from whom they fled. In recognition of the special needs of abused children, Congress enacted Special Immigrant Juvenile Status (SIJS) to provide a previously unavailable child welfare defense to deportation. The remedy is contingent upon a State court declaration that the youth is, in fact, in need of protection. However, unlike their counterparts in foster care or guardianships, youth detained by the federal government face numerous practical and legal roadblocks to accessing the necessary State court declarations. This article identifies several gaps in State laws which impede detained youths' access to State court declarations, and proposes several remedies which would enable the States to carry out Congress' intent that detained youth have access to SIJS, regardless of detention status.     

Supreme Court Elections: How Much They Have Changed,Why They Changed,and What Difference It Makes

This essay draws on four recent studies of elections to state supreme courts in the United States to probe widely perceived changes in the scale and content of electoral campaigns for seats on state supreme courts. 1 Evidence from these studies and other sources indicates that changes have indeed occurred, though they are more limited than most commentaries suggest. These changes stem most directly from trends in state supreme court policy that have attracted interest‐group activity, especially from the business community. Like their extent, the effects of change in supreme court campaigns have been meaningful although exaggerated by many observers. What we have learned about changes in supreme court elections has implications for choices among selection systems, but those implications are mixed and complex.     

Validation and casework application of a Y chromosome specific STR multiplex

A series of validation experiments was performed for a Y chromosome specific STR multiplex system following the suggestions made by the Technical Working Group DNA Analysis Methods (TWGDAM). The multiplex PCR products were detected on Perkin-Elmer 373 and 377 automated sequencers using two labeling colors. No problems regarding the stability, robustness and sensitivity of the Y STR multiplex were observed. Mixture studies revealed a cut off rate similar to autosomal STRs for mixtures of male DNAs and no interference of any female admixture. The comparison of the Y STR results to the autosomal typing results for 56 nonprobative semen stains and swabs, showed a slightly higher success rate in detecting the semen donor's alleles for the Y STR multiplex. Two examples are shown to illustrate the usefulness of Y STR typing for DNA mixtures. In one case the Y STR results confirmed an isolated exclusion; in the other case, the interpretation of a mixture was clarified since the Y STR results proved the presence of DNA from at least two semen donors. Y STR typing is a valuable addition to the forensic DNA testing panel.